Natural stream functions in North Carolina are threatened by changes in watershed hydrology and land use, often resulting in unstable streams with poor habitat and water quality. Over the past decade, natural resource agencies have adopted a natural channel design approach for restoring and enhancing unstable streams and floodplains. This approach is based on the use of reference stream morphology and biology information. Numerous rural and urban stream restoration projects have been implemented by agencies, consultants, Universities, and citizen groups, providing opportunities for evaluation of natural channel design techniques under various conditions. Project evaluation indicates that natural channel design techniques can be effective in improving channel stability and water quality, but several years may be required to observe significant improvements in biological condition. It is important to note that restored stream channels are highly vulnerable during the first few years following construction while vegetation is being established and the stream bed and banks are stabilizing. Most projects require some maintenance and repair during the first few years as channels adjust to new streamflow conditions. This presentation will describe several stream restoration case studies with emphasis on lessons learned to improve the design and implementation of stream restoration.